Dewitt, Gail V 4 moil
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gail V.DeWitt Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/24/2021 87 Years War or Dates
1— Place of Death Hospital,Institution or
Z_City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death El Natural Cause ❑Accident 0 Homicide ElSuicide Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
Christopher Smith MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed ' District Number Register Number
City,Town or Village Glens Falls 5601 541
Burial Date Cemetery,Crematory or Facility Name
11/26/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
0 Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
(1) ❑Transportation
Q by Common Shipment
Carrier Destination
E
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
CC
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/26/2021 Registrar of Vital Statistics Rp6ert,,'IIrew Curtis.('Yectronica/TSrgned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l
Z Date of Disposition J�d9-.2e2/Place ofDisposition 2.)e 1); ' et`- ,nt7-
W (address)
W
°` (section) (lot num r) (grave number)
Name of Sexton or Person in Cha of Premis d/✓('
z � , (please print)
Title 40l. �J_
Signature
DOH-15551o7/18)p t of 2
0153 0
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#